Compliance & Data Analyst

Essen Medical Associates•New York, NY

6d•$66,300 - $70,000

About The Position

NYREACH is a Bronx-based nonprofit focused on addressing health disparities through community-driven solutions. It connects individuals to healthcare and essential social services while building partnerships across New York City. The Compliance & Data Analyst provides oversight, quality assurance, and audit-readiness support for Social Care Network (SCN) activities under New York State’s 1115 Waiver. The role ensures screenings, eligibility determinations, navigation activities, referrals, and documentation meet program requirements, PHS and SOMOS audit standards, and contractual compliance expectations. This position combines compliance leadership with operational analysis. The Analyst develops and maintains operating processes and policies, monitors day-to-day compliance, audits data for accuracy, and works with Navigators, Program Leads, and Directors to maintain consistent compliance, accuracy, and audit readiness across the program. The Analyst also leads SCN audits conducted by PHS, SOMOS, and other oversight entities, and supports audit preparation, responses, corrective actions, and follow-up reporting.

Requirements

Bachelor’s degree required.
Strong understanding of audit processes, documentation standards, and compliance monitoring.
Advanced analytical, reporting, and organizational skills.
Ability to collaborate with Navigators, Program Leads, Directors, and external partners.
Strong attention to detail and documentation accuracy.
Advanced Microsoft Excel skills.
Proficiency in Microsoft Teams, Outlook, Word, and PowerPoint.

Nice To Haves

Master’s degree in public health, health administration, social work, or a related field.
Experience with 1115 Waiver programs, Social Care Networks, Medicaid, or managed care compliance.
Experience supporting internal or external audits in a healthcare or social services setting.

Responsibilities

Ensure eligibility assessments are completed within seven calendar days of referral receipt, track timeliness, retain audit-ready evidence, escalate delays or barriers, and develop workflows supporting timely determinations.
Monitor internal and external referrals for closed-loop completion; follow up on open or aging referrals; verify outcomes are documented accurately; and escalate unresolved referrals that pose compliance risks.
Review member profiles and navigation records for missing or open activities tied to billing opportunities; maintain navigation trackers; validate documentation and eligibility support; and work with Navigators to resolve gaps before billing or reporting.
Ensure notes, eligibility documentation, and care plans meet SCN documentation and audit standards; verify care plans reflect screenings, referrals, and changes in member needs; and enforce standards aligned with PHS, SOMOS, and NYS DOH guidance.
Audit at least 10% of enhanced-level members; validate connections to required referrals and services; document findings, corrective actions, and resolution timelines; and maintain audit logs and supporting evidence.
Review all Client Action items, including internal and external referrals; coordinate with Navigators to obtain responses and documentation; decline or return referrals lacking sufficient documentation or eligibility support; and track closure and resolution status.
Create, document, and maintain SCN operating procedures and compliance policies; keep processes aligned with evolving 1115 Waiver, SCN, PHS, and SOMOS guidance; communicate requirements and updates; and serve as an internal subject matter expert on SCN compliance.
Produce routine compliance, productivity, and audit-readiness reports; monitor indicators for eligibility timeliness, referral closure, documentation quality, and billing readiness; analyze trends and risks; and present findings and recommendations to Directors and executive leadership.
Lead SCN audits conducted by PHS, SOMOS, and other oversight entities; coordinate preparation, data validation, and document submission; support Directors with audit responses, corrective action plans, and follow-up reporting; and maintain continuous audit readiness.
Work toward program performance targets, including at least 95% of eligibility assessments completed within seven days, at least 90% closed-loop referral completion with documented outcomes, at least 95% compliant navigation documentation and care plans, 100% connection of enhanced-level members to required referrals, and 100% timely audit-sample completion and issue resolution.